Healthcare Provider Details

I. General information

NPI: 1174586127
Provider Name (Legal Business Name): KEVIN ELMER ZIMMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ELM ST N
SAUK CENTRE MN
56378-1010
US

IV. Provider business mailing address

10382 AUGUSTA DR
SAUK CENTRE MN
56378-4864
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-2221
  • Fax:
Mailing address:
  • Phone: 320-351-8422
  • Fax: 320-351-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 093033-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: